Provider Demographics
NPI:1568769164
Name:JOHNSON, ELIZABETH (BETSY) JANE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH (BETSY)
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 W SAGEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5104
Mailing Address - Country:US
Mailing Address - Phone:208-407-0688
Mailing Address - Fax:208-391-5550
Practice Address - Street 1:6126 W STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2741
Practice Address - Country:US
Practice Address - Phone:208-407-0688
Practice Address - Fax:208-391-5550
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health